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75 Cards in this Set
- Front
- Back
What are the 4-zone of the prostate that are clinically important?
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Peripheral, cnetral, transitional, periurethral
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What are the 2 major histologic components of the prostate?
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Glands and stroma
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Describe the two types of cells found in prostate glands
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Secretory cells: columnar (face the lumen)… (2) Basal cells: low cuboidal(surrounded by basement membrane)
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What is the stroma composed of? (hint: muscle)
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Modified smooth muscle and dense fibrous muscle
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Where is testosterone converted into DHT? What is the enzyme needed for the conversion? What is DHT?
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Where is testosterone converted into DHT? Stromal cells of prostate… (2) What is the enzyme needed for the conversion? 5∂ reductase… (3) What is DHT? Most potent androgen, which promotes stromal and androgen growth
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Name the 3-type of prostatitis
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Acute bacterial, chronic & non-Bacterial, and Granulomatous prostatitis
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Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated mycobacteria, fungus and BCG?
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Infectious Granulomatous Prostatitis is associated with mycobacteria, fungus and BCG
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Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated E.coli, other gram netative rods, Enterococci or staphylococci?
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Acute Bacterial Prostatis and chronic bacterial prostatitis are associated with E.coli, other gram netative rods, Enterococci or staphylococci
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Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated wth inflamation, and infiltration of neutrophils, micorabscesses, and necrosis?
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Acute Bacterial Prostatitis is associated with inflamation, and infiltration of neutrophils, micorabscesses, and necrosis?
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Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/Postbiopsy/Allergic) Granulomatous, is associated transurethral resection of prostate?
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Postbiobsy granulomas are seen in pts with a hx of transurethral resection of prostate
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Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated recurrent infection due to harboring pathogens in the prostate?
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Chronic Bacterial prostatitis is associated recurrent infection due to harboring pathogens in the prostate?
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Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated eosinophilia?
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Allergic Granulomatous Prostatitis is associated with Eosinophilia (and granulomatous inflammation of other organs)
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Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated urinary tract infections, inflammatory cells in prostate secretions, fever chills, dysuria, and tender boggy prostrate (w/DRE)
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Actue bacterial prostatitis is associated urinary tract infections, inflammatory cells in prostate secretions, fever chills, dysuria, and tender boggy prostrate (w/DRE)
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What is the cause of Non Bacterial prostatitis?
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unknown
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What is the cause of Non-specificGranulomatous?
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unknown
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Which is the most common Granulomatous prostatitis?
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Non specific granulomatous prostatitis is most common
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What ist he disease mechanism of BPH?
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"Enlargement of the gland Both glandular and stromal involvement --> Leading to formation of nodules --> leading to Large nodules compress urethra → leading to partial/complete obstruction
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What is the androgen involvement in BPH? What is the evidence for this?
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" Androgens → ↑ growth… evidence: ↓ 5∂ reducase → ↓ conversion of T → DHT --> improves symptoms
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What is the Estrogen involvement in BPH? (hint: give the mechanism)
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"Estrogen also plays a role in BPH --> Aging men have ↑ E -->Increases androgen receptors -->↑sensitivity to DHT
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What are the zones of involvement of BPH?
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periurethral and transitional zones are involved in BPH
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What is the nodular involvement in BPH?
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"Nodular involvement: compression of surrounding tissue -->pseudocapsule… Urethral walls encroachment by nodules --> leading to obstruction
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What is the general histology BPH? (hint, what is proliferating, glands or stroma?)
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Proliferation of both the glands and the stroma of the prostate
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In the UT obstruction seen with BPH, besides mechanical causes what else causes obstruction with BPH?
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In BPH, besides mechanical obstruction due to the size of the prostate, there is a DYNAMIC INCREASE IN MUSCLE TONE
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When are decreased bladder compliance, frequency, nocturia, and urgency seen in BPH
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Decreased bladder compliance, frequency, nocturia, and urgency are seen in later progression of BPH
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What are the 5 symptoms associated with BPH?
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"↓caliber, ↓ force, Hesitancy, Dribbling, Incomplete emptying
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Why are UTIs seen in BPH?
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BPH --> urine retention --> UTI
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What urinary tract sequelae arise from chronic obstruction due to BPH?
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"In BPH with chronic obstruction: Hydroureter (enlargement)
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What are the 3 medical Rx of BPH? And what effect do each have?
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"Rx for BPH: (1) 5 –alpha-reductase inhibitor (finasteride) --> DHT inhibition → ↓ prostate growth… (2) LHRH analogs (leuprolide), transient LH release w/ long term effect... (3) ∂ adrenergic blocker (which relax smooth muscle)
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Give 4 risk factors for adenocarcinoma of the prostate
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Family history, Race, increased exposure to androgens, high fat diet
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How much does having a first degree relative increase the risk to prostate cancer?
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1° increases a persons risk of developing prostate cancer by 1.5-2.4
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What effect does blocking androgens have on BPH and carcinoma of the prostrate?
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Blocking androgens cause involution of BPH and carcinoma of the prostrate?
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What diet lower one's risk, or raises one's risk, to prostate cancer?
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What diet lower one's risk: Cereals..., raises one's risk, to prostate cancer? Animal fat
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Which vitamin/minerals lower one's risk to prostate cancer?
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Which vitamin/minerals lower one's risk to prostate cancer? Vitamin D, beta-carotene, and Vit-A
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What is the sensitivity of a combination of DRE + TRUS in detecting prostate cancer?
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A combination of DRE + TRUS detects prostate cancer in only 1/3 of all cases.
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Which of the following is incorrect about BPH? Common > 50 y/o… risk increases w/ age… Not always clinical symptoms... increased risk of cancer
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BPH causes no increased risk of cancer
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"Which does the following description describe better, the BPH prostate glands or stroma: Fibroblastic/smooth muscle, Small blood vessels, and Myxoid (mucus-like) matrix… or Epithelial tufting & papillary projections into lumen
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With BPH, the composition of the stroma during BPH is composed of Fibroblastic/smooth muscle, Small blood vessels, and Myxoid (mucus-like) matrix… AND: the glands: have epithelial tufting & papillary projections into lumen
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What are the 3 medical Rx of BPH? And what effect do each have?
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"Rx for BPH: (1) 5 –alpha-reductase inhibitor (finasteride) --> DHT inhibition → ↓ prostate growth… (2) LHRH analogs:
--> Cause transient release of LH → exerts long-term effects (3) ∂ adrenergic blockers --> relaxes sm muscle " |
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Left Grade 1:
➢ Well-circumscribed ➢ Glands: compact regular & medium sized Right: Grade 2: ➢ slightly infiltrated border and ➢ Glands: less regular & less compact, various sizes) |
Name the Gleason Pattern Grade (1-5) for the left side and right sides of this image (note, they are different grades)
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Gleason Grade 3:
➢ Infiltrating the stroma & between benign glands ➢ Glands: various shapes & sizes, w/ lumen & they are discrete (not fused) |
Name the Gleason Pattern Grade (1-5) for this image.
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Gleason Pattern Grade 5
➢ Solid nests OR individual turmor cells ➢ No glandular formation |
Name the Gleason Pattern Grade (1-5) for this image.
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Gleason Pattern Grade 4:
➢ Infiltrating like pattern 3 ➢ Glands: less formed, fused and anastamosed |
Name the Gleason Pattern Grade (1-5) for this image.
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What is TRUS?
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TRUS is transrectal ultrasonography used to detect prostate cancer
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Give the ranges of PSA and what the ramification for these levels:
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Give the ranges of PSA and what the ramification for these levels: Normal <4 ng/mL… 4-10 ng/mL = 25-35% probablility of prostate carcinoma… >10 ng/mL = 42-64% probability of prostate carcinoma
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What percentage of PSA survey (where measurement are <4 ng/mL) is a false negative?
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What percentage of PSA survey (where measurement are <4 ng/mL) is a false negative? 30% are false negative === not great sensitivity
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What does PSA bind to ?
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PSA binds ∂-antichymotrypsin in the plasma
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Which gives greater specificity to prostate cancer, ↑bound PSA w/ ↓ free form → ↑ specificity or ↓bound PSA w/ ↑ free form → ↑ specificity
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↑bound PSA w/ ↓ free form → ↑ specificity to prostate cancer… which really just means that ↓ free form = improved specificity (greater likelihood of prostate cancer and not a false positive)
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If DRE, TRUS and PSA all test positive for prostate cancer, how do you confirm it?
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After (+) DRE, TRUS, and PSA --> Confirmation: transrectal needle biopsy
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Describe the glands in adenocarcinoma of the prostate: size, general description of gland it self, luminal cells, basal cells, nuclei, nucleoli.
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Describe the glands in adenocarcinoma of the prostate: size=SMALL-MEDIUM, general description of gland it self=COMPACT, luminal cells: SINGLE LAYER OF CUBOIDAL/LOW COLUMNAR, basal cells=NO BASAL CELLS, nuclei=LARGE+CLUMPY, nucleoli=PROMINENT.
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What does perineural invasion indicate?
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In the prostate, perineural infiltration is common in adenocarcinoma and helpful in dagnosis
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In diagnosis of prostate cancer, what pathology is seen at low and high magnification?
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Low: small - intermediate sized tumor, decreased stroma, infiltration… HIGH: loss of basal cells, large/clumpy nuclei, prominent nuclei
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What happens to the basal cells in adenocarcinoma of the prostate?
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the end up looking like luminal cells, thus it appears like the basal cells are absent.
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what is meant by infiltration in adenomacarcinoma of the prostrate?
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Infiltration = large sheets of tumor cells near benign glands of the prostate
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Match the Gleason pattern with the following description: slighly infiltrated, glands less regular & less compact with various sizes
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Gleason Pattern 2: slighly infiltrated, glands less regular & less compact with various sizes
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"Match the Gleason pattern with the following description: Infiltrating like pattern 3, with Glands: less formed, fused and anastamosed
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Gleason Pattern 4: infiltrating like pattern 3, but with Glands less formed, fused and anastamosed
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"Match the Gleason pattern with the following description: Solid nests OR individual turmor cells… No glandular formation
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Gleason Pattern 5: Solid nests OR individual turmor cells… No glandular formation
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"Match the Gleason pattern with the following description: Well-circumscribed… w/ Glands: compact regular & medium sized
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Gleason Pattern 1: Well-circumscribed… w/ Glands: compact regular & medium sized
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"Match the Gleason pattern with the following description: Infiltrating the stroma & between benign glands, w/ Glands: arious shape & size, w/ lumen & are discrete
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Gleason Pattern 3: Infiltration of the stroma & between benign glands, w/ Glands: arious shape & size, w/ lumen & are discrete
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Give an example of Gleason Scoring using two scores of 3 and 4
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Gleason score: 3+4=7/10
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Which Gleason score has a better prognosis? High or low?
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Low Gleason scores have a better prognosis
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"Which of the following are true of PIN (prostatic intraepithelial neoplasm): precancerous lesion, most carcinomas develop from PINs, found in 80% of biopsied carcinomas, no nuclear crowding
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Which of the following are true of PIN (prostatic intraepithelial neoplasm): frecancerous lesion, most carcinomas develop from PINs, found in 80% of biopsied carcinomas, no NUCLEAR CROWDING… FALSE, YES there is nuclear crowding
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"Which of the following are true of PIN (prostatic intraepithelial neoplasm): heaped up epithelium lining ducts, doesn't lead to adenocarcinoma of the prostoate, no stromal invasion, no basal cells (no basal cells in invasive carcinoma)
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Which of the following are true of PIN (prostatic intraepithelial neoplasm): heaped up epithelium lining ducts, doesn't lead to adenocarcinoma of the prostoate-FALSE MOST CARCINOMAS DO DEVELOP FROM PIN, no stromal invasion, no asal cells FALSE - THERE ARE BASAL CELLS with PIN(no basal cells in invasive carcinoma)
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T/F PSA is only associate with prostate cancer, but is also seen in BPH.
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TRUE
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What are the 4 factors of staging for prostate cancer?
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"1. Amount of prostate involvement (1 lobe vs 2 lobe)… 2. Confined to prostate… 3. Lymph node… 4. Metastasis
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Match the following with the appropriate stage of prostatic adenocarcinoma (A,B,C,D): microscopic, not palpable, confined to prostate
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Stage A: microscopic, not palpable, confined to prostate
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Match the following with the appropriate stage of prostatic adenocarcinoma (A,B,C,D): palpable tumor, confined to prostate
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Stage B: palpable tumor, confined to prostate
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Match the following with the appropriate stage of prostatic adenocarcinoma (A,B,C,D): Lymph node of distant metastasis
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Stage D: Lymph node of distant metastasis
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Match the following with the appropriate stage of prostatic adenocarcinoma (A,B,C,D): Tumor extending beyond prostatic capsule
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Stage C: Tumor extending beyond prostatic capsule
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T/F: Radical prostatectomy is the gold standard for localized adenocarcinoma confined to prostate. What are the complication of Radical prostatectomy
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True: Radical prostatectomy is the gold standard for localized adenocarcinoma confined to prostate. (2) What are the complication of Radical prostatectomy: incontinence and impotence
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Is Radical prostatectomy with complete removal curative?
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Radical prostatectomy with complete removal IS curative.
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How is Radiation used in prostatic adenocarcinoma?
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"How is Radiation used in prostatic adenocarcinoma? (1) Alternative to radical prostectomy… (2) Adjunct to radical prostectomy (for residual or aggressive dz)
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What are the 5 approaches to Hormonal Rx?
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Orchietomy (castration), Inhibit GnRH, Inhibit androgen synthesis, Inhibit androgen binding to androgen receptor, Inhibit 5∂-reductase
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Name the 3 drugs used to inhibit GnRH.
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"GnRH inhibitors: ➢ Estrogen, Leuporlide, LHRH analog
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Why does hormone induced remission sometimes fail with hormone Rx?
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Why does hormone induced remission sometimes fail with hormone Rx? Tumor ultimately progresses due to eventual emergence of testosterone insensitive clones.
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In the past chemotherapy had been unsuccessful with prostatic adenocarcinoma, when is it used?
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In the past chemotherapy had been unsuccessful with prostatic adenocarcinoma, when is it used? Chemo is used for hormonal refractile metastatic (hormonal resistant cancer)
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In post-op surveilance, (1) does an increase in PSA indicate re-emergence of a tumor? (2) Which is a better prognosis, short or long interval for PSA rise after surgery. (3) which is a better prognosis, short or long doubling time for PSA?
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In post-op surveilance, (1) does an increase in PSA indicate re-emergence of a tumor? NOT NECESSARILY CLINICALLY SIGNFICIANT... (2) Which is a better prognosis, short or long interval for PSA rise after surgery. LONG... (3) which is a better prognosis, short or long doubling time for PSA? LONG
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